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Thomas J.1,2, Martin L.1
1NHS Fife, Dunfermline, United Kingdom, 2Queen Margaret University, Edinburgh, United Kingdom
Background: In the current health care system it is vital that services be monitored for effectiveness and outcomes, as providing an ineffective service is wasteful of money and staff. A day hospital (DH) is a traditional health care setting in which comprehensive assessment and rehabilitation of older frailer adults can be carried out. It is important to evaluate such a service to ensure it remains effective in the changing healthcare environment and for the needs of the ageing population.
Purpose: There is mounting pressure on services due to an increasing number of older adults within the population. This pressure means that services must be aware of factors such as length of stay (LoS) in the service to ensure flow through a patient pathway. However LoS reductions should not mean a compromise on outcomes for patients attending the service. This project aimed to monitor length of stay mapped against both quality of life and physical outcomes.
Methods: It is routine practice within the DH physiotherapy service to complete measures including a timed walk and the EQ-5D-5L on assessment and discharge. Mean gait speed change between assessment and discharge was calculated as the physical outcome marker for patients. The EQ-5D-5L results were entered onto a Chartered Society of Physiotherapy spreadsheet which calculates the time periods between the two results (used to determine LoS) as well as the percentage of people who have improved their scores. These measures were plotted quarterly to enable visualisation of change against length of stay as well as benchmarking against known factors such as a minimal clinical important difference (MCID) for gait speed improvement in older adults.
Results: Measured on an average 40 patients per quarter, the LoS within the DH has reduced overall from 140 to 92 days over the past 2 years. Over the same time period the percentage of patients who have improved their QoL as measured by the ED-5D-5L has increased from 58% to 78%. Mean gait speed improvement has been variable between 11 and 21 m/s; greater than the MCID. Service developments that have driven this change include the introduction of a personal outcome based approach.
Fluctuations due to an increase in pressures on the service were also demonstrated with a period when staffing levels were lower having a greater LoS and decline in QoL and gait speed change, which returned back up to usual levels once the staffing returned to normal.
Conclusion(s): The current service improvements have resulted in a decreased length of stay whilst impacting positively on quality of life for the older people attending the service and not having any detrimental effect on one marker of physical outcome; gait speed. This ongoing quality monitoring has acted as an early warning system during ongoing change to demonstrate any negative impact on outcomes.
Implications: Ongoing quality monitoring is vital as services develop and change. Routine physiotherapy measurement can be used to monitor impact on outcomes as part of this process to ensure physical and QoL outcomes are embedded in quality measurement.
Funding acknowledgements: No funding
Topic: Professional issues
Ethics approval: Ethical approval not required
All authors, affiliations and abstracts have been published as submitted.
